Health Care Use and Delivery

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Concerns about mental and social well-being may strongly influence patients' treatment decisions

Patients' preferences for diverse health states—that is, their mental, physical, and social health—may strongly shape their treatment decisions. For instance, patients may prefer to maintain a certain tolerable quality of life rather than risk additional suffering that could result from high-technology treatments. This is a particularly important point for managed care practices, where concerns have been raised that cost-containment efforts could result in treatment decisions that undervalue patient preferences for their health outcomes, explains Kenneth B. Wells, M.D., M.P.H., of the University of California, Los Angeles.

In a recent study supported by the Agency for Health Care Policy and Research (HS08349), Dr. Wells and his colleagues gathered data from 16,689 adult outpatients visiting 46 primary care clinics in managed care organizations in five States. Two approaches were used to assess the value patients placed on their health status. In the first approach, the patients were instructed to imagine that they had 10 years to live in their current state of health and that there was a treatment that could either give them perfect health or kill them immediately. They were asked what chance of success the treatment had to have before they would accept it. In the second approach, patients were asked about their willingness to undergo a treatment that would result in a shortened life spent in perfect health. The majority of patients (70 percent) were not willing to give up any months of life or take any chance of death for perfect health, but most of these patients considered their current health quite good. Those with chronic medical conditions were more inclined to take a risk.

While concerns about physical health explained 35 to 55 percent of variation in patient treatment preferences, patients also placed a high value on their mental health (20 to 42 percent of preference variation). Almost one-quarter (16 to 23 percent) of the relative contribution to preference variation was due to one's level of social functioning. Mental health was strongly related to health preferences even among patients with chronic medical conditions, such as arthritis or diabetes.

More details are in "What outcomes matter to patients? A study of patient preferences in primary care," by Cathy Donald Sherbourne, Ph.D., Roland Sturm, Ph.D., and Dr. Wells, in the June 1999 Journal of General Internal Medicine 14, pp. 357-363.